Weight Gain After Gastric Sleeve Gastrectomy

Weight gain after sleeve gastrectomy is one of the most researched bariatric surgery topics. In this article, I will share with you what 16 years of obesity surgery has taught me in this regard.

Sleeve gastrectomy is essentially a restrictive method. The shrinking stomach volume greatly reduces the amount of food we take at a time and therefore the amount of calories.

The expansion of the stomach, which is reduced in time after sleeve gastrectomy surgery, reduces the restrictive effect of the small stomach. As the stomach expands, the person can take food more easily.

While the wall thickness of the stomach is approximately 4mm in the lower part, it can thin down to 1mm in the upper part. Since the upper part of the stomach is thinner and more flexible, there may be expansion in this part after years after sleeve gastrectomy surgery. In a medical article published years ago, it was described that the stomach expands both from the upper and lower parts after sleeve gastrectomy surgery, almost like an hourglass.

You may wonder how the lower part of the stomach expands even though it has thick walls. The explanation for this is actually quite simple; I remember very well 11 years ago when I was receiving training on this subject in the U.S.A., the first description of the sleeve gastrectomy method was different. In sleeve gastrectomy surgery, the lower part of the stomach was cut at a distance of about 6 cm from the gastric outlet valve. This distance has been reduced to 2 cm today. The upper part is cut at a distance of about 1 - 2 cm from the point where the esophagus and stomach meet, which was the same 11 years ago.

In sleeve gastrectomy surgery, the midpoint of the stomach is actually the narrowest part. The reason for this is the curved shape of the stomach, which is almost like a bean grain, and the stepler device we use can make 6 cm first straight cuts. We can follow the line while cutting a paper in our hands and we can rotate the paper according to the plane of the scissors or rotate the scissors while closing the ends of the scissors. During sleeve gastrectomy surgery, after fixing the stomach or the stapler, we cannot rotate either of them during the cutting phase. Therefore, at the middle point where the stomach fold is sharpest, the stapler line comes very close to the stomach wall. Although a guide plug is inserted into the stomach in sleeve gastrectomy surgery, due to the elastic tissue of the stomach, stenosis can occur at the middle point of this stomach despite the plug. The stenosis at this point restricts the person's food intake and keeps him/her weak. If this stenosis is mild, it does not cause problems, but if it is severe, it causes prolonged vomiting.

Causes of Weight Gain After Gastric Sleeve Gastrectomy

The most common reason for weight regain after sleeve gastrectomy is the loss of the restrictive feature of the stomach as mentioned in detail above. As we mentioned above, sweet strictures allow the patient to stay thin for a longer period of time. It does not make sense to me to try to explain the patient's weight regain after bariatric surgery with the patient's return to his old habits. Of course, eating high-calorie foods that do not stay in the stomach for a long time reduces weight loss performance, but the restrictive effect of the tube created by sleeve gastrectomy surgery can keep the person thin for many years.

In summary, the main issue we need to focus on to minimize the problem of weight gain after sleeve gastrectomy is the way the stomach is formed. The sleeve gastrectomy method, which is seen as the simplest surgery of bariatric surgery, can actually be said to be performed like a sculptor when considered in the light of the above-mentioned determinations.